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Expanding access to male circumcision in Zambia: The ZPCT II experience

December 01, 2012

This piece originally appeared on FHI 360's Degrees Blog. You can read the original text here

By Michael Welsh, PhD, MA, FHI 360 Country Director in Zambia, and Patrick Katayamoyo, MD, MPH, Associate Technical Director, ZPCT II

Voluntary medical male circumcision (VMMC) is among the most efficacious HIV prevention tools available, reducing the risk of acquisition by as much as 60 percent according to published data from randomized clinical trials. Over five years ago, a statement from the World Health Organization and the Joint United Nations Programme on HIV/AIDS was a call to arms in the fight against HIV and AIDS: “the efficacy of male circumcision in reducing female-to-male HIV transmission has now been proved beyond reasonable doubt.” It has been clear that promoting and providing male circumcision services is urgent in countries with low levels of male circumcision and high rates of heterosexually acquired HIV infection, such as Zambia.

The Government of Zambia has embraced this challenge enthusiastically, and FHI 360 is proud to be part of the national effort to expand access to male circumcision. Through the Zambia Prevention Care and Treatment Partnership (ZPCT II), supported by the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), FHI 360 and its partners are working with the Zambian Ministry of Health to expand access to safe VMMC as part of a comprehensive package that also includes HIV counseling and testing, condom promotion, management of sexually transmitted infections and risk-reduction counseling. ZPCT II focuses on both the supply and demand side of male circumcision services and supports services at standing health facilities and through mobile outreach. Demand creation activities include: outreach campaigns to schools, workplaces and other places where men congregate; engagement of community leaders and neighborhood health committees; engagement of satisfied clients to serve as male circumcision champions in their communities and through mass media; referral of HIV-negative clients from counseling and testing services; and use of other forms of interpersonal communication and educational materials. On the supply side, ZPCT II provides training for health care workers (medical officers, clinical officers and nurses) followed by post-training, on-site mentoring and quality assurance. In addition, ZPCT II provides equipment, supplies and other related commodities needed for quality VMMC service provision. Finally, the services benefit from a strong monitoring and evaluation component, so that both achievements and challenges can be tracked for reporting and management purposes.

The chart below demonstrates the ZPCT II achievements in male circumcision over twelve recent months. ZPCT II is supporting male circumcision services in six of Zambia’s 10 provinces, covering 38 districts and 55 health facilities. Over these months (October 2011 through September 2012), we saw a steady increase in the number of male circumcisions performed in both the standing facilities and through the community outreach activities, with 10,635 male circumcisions done at mobile sites and 12,586 at standing sites. The notable spike in August and September highlights the impact of a national VMMC promotional campaign.

We have learned that uptake for VMMC can be significantly increased by bringing the service closer to the community through outreach and effective community mobilization, and that focused national campaigns are effective in accelerating update. Zambia cumulatively performed over 250,000 male circumcisions by September 2012, and there are plans to conduct 1.9 million by 2015. Both the Zambian and the U.S. governments are focused on the expanding access to male circumcision in Zambia, and ZPCT II and its partners are poised to continue to make important contributions in this campaign.